Materials and Approaches for Optical Stimulation of the Peripheral Nervous System

ABSTRACT

A variety of methods, devices, systems and arrangements are implemented for stimulation of the peripheral nervous system. Consistent with one embodiment of the present invention, method is implemented in which light-responsive channels or pumps are engineered in a set of motor units that includes motor units of differing physical volumes. Optical stimuli are also provided to the light-responsive channels or pumps at an optical intensity that is a function of the size of motor units to be recruited. In certain implementations, the intensity of the optical stimuli is increased so as to recruit increasingly larger motor units.

RELATED PATENT DOCUMENTS

This patent document claims the benefit, under 35 U.S.C. §119(e), ofU.S. Provisional Patent Application Ser. No. 61/079,035 filed on Jul. 8,2008, and entitled “Materials and Approaches for Optical Stimulation ofthe Peripheral Nervous System;” the underlying provisional applicationis fully incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates generally to stimulation of the peripheralnervous system, and more particularly to arrangements and approachesinvolving optical stimulus to affect the cells of the peripheral nervoussystem.

BACKGROUND

The peripheral nervous system extends from the brain and spinal cord tovarious portions of the body. Two of the main functions of theperipheral nervous system are muscle control and sensory feedback.Peripheral nerves carry signals between the various portions of the bodyand the central nervous system using electrical signals.

A typical muscle is composed of many thousands of fibers, which containthe contractile machinery of the muscle. Rather than individuallycontrolling each fiber, a single motor neuron can control groups offibers that form motor units. Motor units vary in size from 100 toseveral hundred fibers, and also vary in composition of muscle fibertype. Small motor units are typically composed of slow type musclefibers that are fatigue-resistant, while larger motor units aregenerally composed of fast type fibers that are easily fatigable andmedium sized motor units consist of a mixture of slow and fast fibertypes. Motor units are recruited, or turned on, in a specific order thatgenerally begins with the smallest group and progresses to the largestgroup. In this way, the smaller, fatigue-resistant motor units are usedmore often, and thus allow for fine force control for longer periods ofuse. The larger motor units, with larger capacity for generating force,are conserved for brief periods of time when they are most needed, e.g.,during a reflex, emergency or other strenuous activities. The size of amotor neuron is correlated to the size of the motor unit that the motorneuron controls, so that a large motor neuron will control a large motorunit.

The normal physiologic recruitment order refers to a typical (healthy)order of motor neuron recruitment, where the size of the motor axons andthe motor neuron cell bodies define the sequence of recruitment. For agiven synaptic input of current, a smaller motor neuron will berecruited before a larger motor neuron, thus determining the order,small to large.

External electrical stimulation of motor neurons has been attempted. Onesuch attempt stimulates the axon of a motor neuron. This, however,results in a recruitment order that is reversed when compared to thenormal physiologic order (the larger motor units are recruited beforesmaller ones). The implication of this recruitment reversal is thatlarge, fatigable motor units are recruited first, resulting in the lossof fine motor control and sustained motor function. Thus, fatigue hasbecome a limiting factor in limb reanimation projects that haveattempted to use electrical stimulation.

The other type main function of the peripheral nervous system, sensoryfeedback, is responsible for pain, touch, appetite and a variety ofother aspects. When problems with arise with sensory feedbackmechanisms, the results are often drastic and sometimes even lifethreatening. For example, chronic pain is a serious health issue thataffects many individuals, seriously degrading their quality of life andoften having long-term psychological impact. Another issue addressablethrough sensory feedback relates to appetite suppression.

Aspects of the present invention relate to control and/or stimulation ofperipheral nervous system using optical stimulus.

SUMMARY

Aspects of the claimed invention relate generally to stimulation of theperipheral nervous system, and more particularly to arrangements andapproaches involving optical stimulus to affect the cells of theperipheral nervous system.

Consistent with an embodiment of the present invention, a method isimplemented in which light-responsive channels or pumps are engineeredin a set of motor units that includes motor neurons of differingphysical volumes. Optical stimuli are also provided to thelight-responsive channels or pumps at an optical intensity that is afunction of the size of motor units to be recruited. In certainimplementations, the intensity of the optical stimuli is increased so asto recruit motor units having increasingly larger motor neurons.

Embodiments of the present invention relate to a method wherelight-responsive channels or pumps are engineered in a set of peripheralafferent nerves. Optical stimuli are provided to the light-responsivechannels or pumps to mitigate pain. Specific implementations relate tothe expression of NpHR in the peripheral afferent nerves while providingoptical stimuli to modify pain recognition in the central nervoussystem.

An embodiment of the present invention relates to a method in whichlight-responsive channels or pumps are engineered in a set of vagalfibers associated with the gastrointestinal system. Optical stimuli areprovided to the light-responsive channels or pumps.

Consistent with other embodiments of the present invention,light-responsive channels or pumps are engineered in a set of stemcells. The set of stem cells are implanted at a target location, andoptical stimuli are provided to the light-responsive channels or pumpsto cause activation of muscle at the target location. Specificembodiments relate to the use of skeletal muscle stem cells torepopulate muscles or implanting the set of stem cells for myocardialrepair.

Other embodiments of the present invention relate to a device, kit orsystem having delivery component for expression of light-responsivechannels or pumps in the peripheral nervous system and having an opticalcomponent for providing optical stimulus to the light-responsivechannels or pumps in the peripheral nervous system. In a particularimplementation, the delivery component includes a nucleic acid moleculecapable of transporting the light-responsive channels or pumps to whichit has been operatively linked.

The above summary of the present invention is not intended to describeeach illustrated embodiment or every implementation of the presentinvention.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention may be more completely understood in consideration of thedetailed description of various embodiments of the invention thatfollows in connection with the accompanying drawings, in which:

FIG. 1A depicts a peripheral nerve stimulated by optical stimulusdevices, consistent with an embodiment of the present invention;

FIG. 1B shows muscle fibers controlled by a set of light-responsivemotor neurons, according to an example embodiment of the presentinvention;

FIG. 2 shows a light stimulation device for placement around peripheralnerves, according to an example embodiment of the present invention;

FIG. 3 shows a system for stimulating motor neurons, according to anexample embodiment of the present invention;

FIG. 4A shows a block diagram of an implantable device, according to anexample embodiment of the present invention;

FIG. 4B shows a circuit diagram corresponding to the block diagram ofFIG. 4A, according to an example embodiment of the present invention;

FIG. 5A shows a stimulation cuff for placement around a peripheralnerve, consistent with an embodiment of the present invention;

FIG. 5B shows the muscles electrical response (M-wave) as measured byfine wire electrodes placed in the muscle belly and near the Achillestendon, consistent with an embodiment of the present invention;

FIG. 5C shows the contractile force output as measured by a forcetransducer attached to the Achilles tendon, consistent with anembodiment of the present invention;

FIG. 5D depicts electromyography (EMG) and force traces from twitcheselicited by optical and electrical stimulations in both Thy1-ChR2animals and control C57bl/6 animals, consistent with an embodiment ofthe present invention;

FIG. 6A shows peak force during a single twitch vs. rectified integratedEMG for both electrical and optical stimulations, consistent with anembodiment of the present invention;

FIG. 6B depicts average latency measured from initiation of stimuli todetection of EMG, consistent with an embodiment of the presentinvention;

FIG. 6C shows the average contraction time measured from 10% of peakforce to peak force, consistent with an embodiment of the presentinvention;

FIG. 6D depicts average relaxation time measured from peak force to 10%of peak force, consistent with an embodiment of the present invention;

FIG. 7A shows rectified-integrated EMG (iEMG) vs. estimated opticalintensity at the surface of the sciatic nerve for soleus (SOL) andlateral gastrocnemius (LG), consistent with an embodiment of the presentinvention;

FIG. 7B shows rectified-integrated EMG vs. electrical stimulationvoltage applied to the sciatic nerve, consistent with an embodiment ofthe present invention;

FIG. 7C shows optical intensity required to achieve maximum iEMG in SOLand LG, consistent with an embodiment of the present invention;

FIG. 7D shows electrical stimulation required to achieve 95% of maximumiEMG in SOL and LG, consistent with an embodiment of the presentinvention;

FIG. 7E shows an example cross-section of the sciatic nerve whereretrograde dye was injected into the LG only, scale bar=100μ consistentwith an embodiment of the present invention;

FIG. 7F shows distribution of motor axon diameters for SOL and LG foundin cross-section of the sciatic nerve, consistent with an embodiment ofthe present invention;

FIG. 7G shows depth of motor axons for SOL and LG found in cross-sectionof the sciatic nerve, consistent with an embodiment of the presentinvention;

FIG. 8A depicts a confocal image of sciatic nerve in cross-section,consistent with an embodiment of the present invention;

FIG. 8B depicts a confocal image of sciatic nerve in a longitudinalsection with the same staining as in FIG. 8A, illustrating several nodesof Ranvier (gaps formed between myelin sheaths of cells), scale bar is50 μm, consistent with an embodiment of the present invention;

FIG. 8C shows YFP fluorescence intensity versus motor axon size incross-section (n=4), consistent with an embodiment of the presentinvention;

FIG. 8D shows the average fluorescence intensity parallel to the longaxis of sampled axons, where the origin indicates the center of the nodeof Ranvier (n=15, shaded region is standard deviation (s.d.)),consistent with an embodiment of the present invention;

FIG. 9A shows the average tetanic tension over two minutes in musclebeing stimulated with 250 ms trains at 1 Hz using electrical and opticalstimulation (n=7, shaded region is standard error (s.e.)), consistentwith an embodiment of the present invention;

FIG. 9B shows the average fatigue index for electrical and opticalstimulation, measured as decline in tetanic tension over two minutes(n=7, error bars are s.e., * indicates p<0.01), consistent with anembodiment of the present invention; and

FIG. 9C shows an example of tetanic tension taken from a single mouseusing both optical and electrical stimulation in contralateral hindlimbsover 20 minutes, consistent with an embodiment of the present invention.

While the invention is amenable to various modifications and alternativeforms, examples thereof have been shown by way of example in thedrawings and will be described in detail. It should be understood,however, that the intention is not to limit the invention to theparticular embodiments shown and/or described. On the contrary, theintention is to cover all modifications, equivalents, and alternativesfalling within the spirit and scope of the invention.

DETAILED DESCRIPTION

The present invention is believed to be applicable to a variety ofdifferent types of processes, devices and arrangements relating tostimulation of peripheral nerves. While the present invention is notnecessarily so limited, various aspects of the invention may beappreciated through a discussion of examples using this context.

According to one embodiment of the present invention, peripheral nervesare optically stimulated to activate light-responsive molecules therein.The light responsive molecules can inhibit and/or facilitate electricalsignaling (e.g., action potentials) within the peripheral nerves. Forinstance, many peripheral nerve bundles include mixed types of nerves(e.g., motor and sensory). One or both of the nerve types can beaffected by optical stimulation. In specific instances, each of thenerve types can be selectively stimulated.

As used herein, stimulation can include either activation ordeactivation of electrical signaling in the nerves. For instance, nervecells are stimulated by adjusting the membrane voltage level of thenerve cell to facilitate action potentials or to inhibit actionpotentials. Moreover, for various embodiments of the present invention,the temporal precision of various light responsive molecules allow forcontrol of individual action potentials, whether the control is viafacilitation or inhibition.

According to an embodiment of the present invention, a cuff-shapedoptical delivery device allows for stimulation of both types of nerves,or for selective stimulation. These and other implementations can beused for treatment of various conditions, such as muscle spasticity,among other things.

According to an example embodiment of the present invention, motorneurons are optically stimulated. The optical stimulus activates ionchannels and/or pumps in the motor neurons to excite or inhibit neuralactivation and thereby affect contractions and/or relaxation of muscletissue. Properties of light stimulus can be modified to allow forvariations in the effect on the muscle tissue.

A specific embodiment of the present invention uses variation of theintensity of the optical stimulus to control activation of motor neuronsengineered with light responsive ion channels or pumps. It is believedthat different motor neurons will respond differently to light ofvarying intensities. The differing responses can be particularly usefulfor selectively producing coarse and fine contractions. Other propertiesof light that can be used to control responsiveness of motor neuronsinclude, but are not limited to, wavelength, spatial location andtemporal properties (e.g., pulse duration or pulse separation).

Motor neurons use electrical signaling to transmit control signalsbetween portions of the nervous system and muscle fibers. The electricalsignals take the form of electrical pulses or action potentials. Anaction potential is a voltage pulse that travels along the membrane ofthe motor neuron. An action potential is generated when the membranevoltage reaches a threshold voltage level. An action potential of themotor neuron results in the release of chemicals (neurotransmitters).These chemicals cause the muscle fiber to contract.

One embodiment of the present invention uses light to activatelight-responsive cation channels in the motor neuron. Light ofsufficient intensity and wavelength activates the cation channels, whichinduces a current in the motor neuron. The induced current moves themembrane voltage toward the threshold voltage necessary to produce anaction potential. If sufficient current is induced, an action potentialis generated and the muscle fibers of the corresponding motor unit areactivated.

One embodiment of the present invention involves introducinglight-activated cation channels in one or more motor neurons. Onemechanism for introducing the cation channels involves the use ofvectors, such as lentiviruses, retroviruses, adenoviruses and phages.The vectors are introduced to the motor neurons and result in expressionof the gene for the light-activated cation channels.

Surprisingly and consistent with embodiments of the present invention,it has been discovered that optical stimulation can be used to recruitmotor units in a largely normal physiologic order. The number oflight-activated channels opened is proportional to the intensity of thelight that is applied. Although not bounded by theory, it is believedthat the density of light-activated channels (e.g., using vectors) isrelatively uniform between different sized motor neurons. As the size ofa motor axon increases, the membrane area increases by the power of two,while the motor axon volume increases by the power of three. The numberof light-activated channels relates more directly to the membrane areaas opposed to the motor axon volume. Therefore, as a motor axonincreases in size, the volume increases at a rate such that larger motoraxons have fewer light-activated channels per volume. This implies thatfor a given light intensity, motor neurons of smaller motor units have afaster change in voltage due to the light-activated channels.Accordingly, smaller motor neurons exhibit larger changes in membranepotential than larger motor neurons. Thus with increasing lightintensity, the size of motor units recruited also increases, matchingthe normal physiologic order.

Embodiments of the present invention are implemented with knowledge ofthese unexpected results. For instance, the optical stimulus profile(e.g., optical intensity, optical frequency or spatial location) can beset as a function of the size of motor unit/neuron to be recruited. Alookup-table or an algorithm can be used to associate a desired muscleresponse with a particular optical profile. According to one suchimplementation, the optical stimulus profile can be set according to amuscle fatigue factor. Due to the activation of smaller motor neuronsbefore larger motor neurons, measurements of the muscle fatigue can beused to determine the point at which motor neurons of increasinglylarger size are recruited. The experimental results presented hereinprovide examples of fatigue-based determinations that are consistentwith embodiments of the present invention.

Another factor that can be used includes the contractile response(strength and/or speed) of recruited motor units. The contractileresponse can be correlated to the size of the motor units/neurons thatwere recruited under a specific optical stimulus profile. The opticalstimulus is then determined as a function of the desired contractileresponse of the muscle. The contractile response can be measured by avariety of different mechanism. Non-limiting examples include forceand/or speed measurements caused by muscle contraction or monitoring ofmuscle activation (e.g., electromyography (EMG) measurements).

Such factors are but a few of the possible mechanisms for determining anoptical stimulus profile. Other factors can include, for example, thelocation, size and/or type of muscle tissue under stimulus. Moreover,different species may require different stimulus profiles and/ordifferent stimulus devices. The age, physical size and fitness of thepatient can be used as factors in determining an optical stimulusprofile.

Various other determinable factors are contemplated for determining theoptical stimulus profile, many of which are facilitated by knowledge ofthe orderly recruitment of motor units that can be provided byembodiments of the present invention. Accordingly, while the inventionis not limited to orderly recruitment of motor units, variousembodiments are facilitated by this aspect.

Turning now to the figures, FIG. 1A depicts a peripheral nervestimulated by optical stimulus devices, consistent with an embodiment ofthe present invention. Nerve trunk 101 includes nerve bundles 111 and113. The nerve bundles 111 and 113 are engineered to include lightresponsive channels/pumps. Optical stimulus devices 103 and 107 provideoptical stimulus to the engineered light-responsive channels/pumps.Although not limited thereto, optical stimulus devices 103 and 107 aredepicted as light-emitting diodes (LEDs) controlled by optical controlcircuits 105 and 109, respectively.

In one implementation, a single optical stimulus device 103/107 can beused. In other implementations, multiple optical stimulus devices103/107 are possible. The optical stimulus devices can operate at thesame wavelength of light or at different wavelengths of light. Whenoperating at the same wavelength of light, the use of multiple opticalstimulus devices can increase the intensity of the provided opticalstimulus, increase the area of optical stimulus and/or provide spatiallycontrollable optical stimulus. For instance, the physical location ofthe optical stimulus devices can be used as a factor in the stimulationof the light-responsive channels/pumps. Due to relative position of thedevices, morphology of the nerve trunk or other factors, the devices canprovide different responsiveness of the nerves and associated functions.

Optical control circuits 105 and 109 can also be implemented so thatindividual control of the optical stimulus devices is possible. This canbe particularly useful for implementations where the optical stimulusdevices operate at different wavelengths. Different types of lightresponsive channels/pumps can be designed to have a different wavelengthfor the optimal responsiveness. In a particular embodiment of thepresent invention, the differences in the wavelengths are sufficient toallow for activation of one type of light responsive channel/pumpwithout activating the other type of light responsive channel/pump. Inthis manner, a first type (e.g., ChR2) of channel/pump can be used tofacilitate activation (action potentials) in a nerve and a second type(e.g., NpHR) of channel/pump can be used to inhibit activation (actionpotentials) in a nerve. Other possibilities include the targeting of thefirst type of channel/pump to a first type of cell (e.g., slow twitchmotor unit) and the second type of channel/pump to a second type of cell(e.g., fast twitch motor unit).

These examples show the wide variety of applications and possibleapplications for embodiments of the present invention. A number of suchembodiments, including those discussed in connection with the variousfigures, are directed to control of muscle fibers through opticalstimulation of motor neurons. Other embodiments, some of which areexpressly discussed herein, are also contemplated. For instance,peripheral nerves also provide sensory responses (e.g., pain, touch orappetite). A number of disorders are associated with abnormal sensoryresponses. Accordingly, various embodiments relate to treatment orcharacterization of various sensory-related disorders.

FIG. 1B shows muscle fibers controlled by a set of light-responsivemotor neurons, according to an example embodiment of the presentinvention. Muscle fibers 100 are responsive to motor units 104, 106 and108. Each motor unit responds to a different motor neuron. Motor unit104 has a motor neuron with a relatively low threshold, meaning that themotor neuron is responsive to a lower amount of stimulus. Motor unit 106has a motor neuron with a relatively high threshold, and motor unit 108has a motor neuron with threshold between the other two motor neurons.Under normal physiologic recruitment, this would allow for theactivation of motor unit 104 without activating motor units 106 or 108and for the activation of motor unit 108 without activation motor unit106.

In a specific implementation, the motor neurons includeproteins/molecules that function as light-activated ion channels orpumps. Light source 102 provides light to the light-activated ionchannels or pumps. If the light is sufficient to activate thelight-responsive molecules, ion flow across the membrane modifies themembrane voltage of the motor neurons. As the intensity of the lightincreases, the percentage of light-responsive molecules that areactivated also increases. Thus, light intensity can be used to activatethe smaller motor units without activation of the larger motor units.

It should be noted that factors other than light intensity can play arole in the activation of the light-responsive molecules. For example,the wavelength of light can also have an effect on activation of motorunits. For example, increasing the intensity of light at a specificwavelength may have little or no effect when the wavelength is outsideof an effective absorption band (i.e., wavelengths that the moleculesrespond to) for light-responsive molecules. In another example, shiftingthe wavelength of the light relative to the effective absorption bandcan change the percentage of light-responsive molecules that respondwithout modifying intensity of the light. Other examples involve theduration of the light and/or the spatial location of the delivered lightrelative to the motor neurons.

In one implementation, the application of the optical stimulus isresponsive to a sensed neural activation. For instance, a damagedportion of a nerve can be effectively bypassed by sensing neuralactivation signals and providing responsive optical stimuli at a pointbeyond the damaged portion of the nerve. In one implementation, thesensed neural activation can be neural activation within the nerve, butprior to the damaged portion. In another implementation, the sensedneural activation could be from an otherwise unassociated portion of thenervous system. For this second type of implementation, the patient canretrain the neural pathways to control the damaged nerve using thepreviously unassociated portion of the nervous system. Another exampleof sensed activation includes sensing muscle activation more directly(e.g., using an EMG). In response to sensed activation, optical stimuluscan be provided to recruit additional motor units. In this manner, themuscle activation can be increased by the application of an opticalstimulus profile.

FIG. 2 shows a light stimulation device for placement around peripheralnerves, according to an example embodiment of the present invention.Light stimulation device 202 surrounds motor neurons 204 and 206. Motorneurons 204 and 206 can be of different sizes, allowing for selectiveactivation thereof. In one implementation, stimulation device 202 canvary the intensity of the generated light as desired so as to allow forselective activation of certain ones of the motor neurons.

Embodiments of the present invention include implementations of lightstimulation device 202 that do not surround motor neurons 204 and 206.For example, light stimulation device 202 can be implemented using aU-shaped cuff that is designed to be placed proximate to the motorneurons. Other shapes are possible, including point light sources, suchas an optical fiber.

In certain implementations light stimulation device 202 is attached toan arm (not shown) that can be used to guide the light stimulationdevice 202 near the motor neurons 204 and 206. If desired, the arm canbe subsequently removed. Alternatively, the arm can be left in place andused the help fix the position of light stimulation device 202, provideadjustment of the position of light stimulation device 202 and/orprovide power/control signals to light stimulation device 202.

FIG. 3 shows a system for stimulating motor neurons, according to anexample embodiment of the present invention. Motor units (motor neuronsand muscle fibers) 302 include light responsive ion channels/pumps.Light generator 308 includes one or more light sources 304 thatstimulate the channels/pumps within the motor units. Parameter controls306 allow for control of light sources 304 by modifying the lightproperties. The modification of parameters can be implemented so as toallow for activation of some motor units without activating others. Forexample, the intensity of the light can be set at a level that activatessome motor units and not others. In another instance, the wavelength oflight can be changed, thereby achieving much the same effect asmodifying the intensity of the light. Other possibilities includeactivating only some of the light sources 304, or using different lightparameters for certain light sources 304.

Motor unit monitor 310 provides feedback on the activation of the motorunits. The feedback can be implemented using a number of differentmeasurements. For example, motion associated with the muscle can bemonitored to determine the strength of the contraction using a pressuresensor, speed of the movement using image capture and/or the precisenessof the movement (e.g., smooth or jerky). In some instances it may alsobe possible to measure the electrical responsiveness of the motor units.As the stimulus is optical and not electrical, the electrical signalsrepresent the results of the stimulus without separating the (optical)stimulus signals from the (electrical) results thereof. These and otherresults can be stored in a results database 316.

Control unit 312 can be used to generate stimulus profiles that are usedto control the light generator 308. These profiles can be stored withina stimulation profile database 314. In one implementation, a sequence ofprofiles are implemented and correlated to the results stored in resultsdatabase 316. The desired muscle response can then be implemented byproviding a stimulation profile that is correlated to the desiredresult.

According to a specific embodiment of the present invention, bothinhibitory and excitation molecules are implemented to provide controlof the motor units. In certain instances this can provide furtherdelineation between activation of different motor units by, for example,enabling both the inhibitory and excitation molecules. This caneffectively reduce the likelihood of a motor neuron action potential(relative to enabling the excitation molecules without enabling theinhibitory molecules). In certain instances, stimulation for inhibitionand excitation can be provided at different spatial locations. This canallow for each of the inhibition and excitation stimulus to morestrongly affect different motor neurons, respectively.

In one embodiment of the present invention, an implantable deviceincludes a control portion that responds to magnetic fields. Thiscontrol portion can be implemented as an electrical wire, resistiveelement or other responsive element. In such an embodiment, theintensity, duration and frequency of light generated would be controlledby the current generated from an introduced magnetic field. This can beparticularly useful for creating inexpensive, long lasting and smalldevices. An example of such an embodiment is discussed further inconnection with FIG. 4A and FIG. 4B.

In another embodiment of the present invention, the control portion canbe implemented as a more complex circuit. For instance the controlcircuit may include and otherwise implement different rectifiercircuits, batteries, pulse timings, comparator circuits and the like. Ina particular example, the control circuit includes an integrated circuit(IC) produced using complementary metal-oxide-semiconductor (CMOS) orother processes. Integrated circuit technology allows for the use of alarge number of circuit elements in a very small area, and thus, arelatively complex control circuit can be implemented for someapplications.

In a particular embodiment of the present invention, the lightgenerating portion is a blue LED, such as LEDs in 0603 or 0805 packagesizes. A particular example is a blue surface mount LED having partnumber SML0805, available from LEDtronics, Inc (Torrance, Calif.).

FIG. 4A shows a block diagram of an implantable device, according to anexample embodiment of the present invention. FIG. 4A shows an inductorcomprising coils 402 and core 404 connected to LED 408 using conductivepaths shown by 406. FIG. 4B shows a circuit diagram corresponding to theblock diagram of FIG. 4A. Inductor 412 is connected in parallel to LED410. Thus, current and voltage generated by changing a magnetic fieldseen at inductor 412 causes LED 410 to produce light. The frequency andstrength of the changing magnetic field can be varied to produce thedesired amount and periodicity of light from LED 410.

Examples of light stimulation devices are taught by InternationalApplication No. PCT/US08/50628, entitled System for Optical Stimulationof Target Cells, to Schneider et al., and filed Jan. 9, 2008. The patentdocument teaches a variety of devices and delivery devices for use withlight-responsive molecules. As such, the document is hereby incorporatedby reference in its entirety.

There are a number of suitable light-responsive molecules that can beused to modify nerve cells so that the cells are optically responsive.One class of molecules facilitates action potentials in the nerve cellsby inducing ionic current that moves the membrane voltage toward thevoltage threshold of the cell. In one embodiment of such a molecule, thelight-responsive molecule is one of the proteins ChR2, Chop2, ChR2-310,or Chop2-310. In another embodiment, the light-responsive molecule is a7-transmembrane protein. In another embodiment, the light-responsivemolecule is a single-component protein. In yet another embodiment, thelight-responsive molecule covalently binds retinal. For further detailson light responsive molecules reference can be made to theaforementioned System for Optical Stimulation of Target Cells, to TheBoard of Trustees of the Leland Stanford Junior University, which isfully incorporated herein by reference.

Another class of molecules discourages action potentials in the nervecells by inducing ionic current that moves the membrane voltage awayfrom the voltage threshold of the cell. In one embodiment, the lightresponsive molecule is an archaeal light-driven chloride pump (NpHR)from Natronomonas pharaonis. For further details on such lightresponsive molecules, reference can be made to Zhang et al., (2007)Multimodal Fast Optical Interrogation of Neural Circuitry, Nature 2007Apr. 5; 446(7136):617-9, which is fully incorporated herein byreference. These and other molecules can be used alone or in conjunctionwith one another.

A few specific examples of light responsive molecules, their use andstimulation devices and techniques (e.g., ChR2 or NpHR) are provided inU.S. patent application Ser. No. 11/459,636, entitled Light-ActivatedCation Channel and Uses Thereof, to Boyden et al., and filed Jul. 24,2006; in International Application No. PCT/US2008/050628, entitledSystem for Optical Stimulation of Target Cells, to The Board of Trusteesof the Leland Stanford Junior University and filed on Jan. 9, 2008; andalso in U.S. patent application Ser. No. 12/041,628, entitled Systems,Methods and Compositions for Optical Stimulation of Target Cells, toZhang et al., and filed on Mar. 3, 2008. These documents teach a numberof different light responsive molecules (including, but not limited to,specific sequence listings) as well as variants thereof. These documentsinclude numerous discussions of example molecules as well as deliveryand stimulation techniques. As such, these documents are herebyincorporated by reference in their entirety.

A particular embodiment uses a two-part approach: expression of ChR2 (orNpHR in other cases) in the neurons of interest, followed byimplantation of a light source to illuminate the nerve at the specifiedfrequency. ChR2 expression can be achieved through “projectiontargeting”, whereby opsin vectors are injected not at the site ofeventual illumination, but at a distant site where the cell bodies ofthe target neurons lie. Alternately, target muscles can be infused witha retrograde virus; in this approach, one does not need to know celltype-specific promoters, and only the axons of the targeted cells areoptically modulated even though they may be intermixed with other celltypes in the nerve. Unlike other optically-responsive channels that havebeen developed, although ChR2 and NpHR require an all-trans-retinal(ATR) chromophore as a cofactor, retinoids naturally present inmammalian cells are sufficient.

A specific implementation uses an LED-based nerve cuff, where severalmicro LEDs are embedded in a solid, optically transparent cuff, andsurgically placed around the desired nerve. This cuff provides highintensity light source for stimulating the desired nerve. A specificexample light intensity for ChR2 stimulation is >1.0 mW/mm² light powerdensity. Embodiments of the present invention allow for alternatives toLEDs, such as solid state laser diodes, or some future technology.Considerations for selection of the light source can include efficiencyconcerns in terms of size, expense, heating, and battery life.

The following description provides details relating to an experimentalmouse model for such therapies, as well as evidence that opticalstimulation recruits muscle fibers in a normal (healthy) physiologicorder, thereby avoiding the problem faced by electrical stimulation.Human nerves are generally larger and the technology is therefore scaledaccordingly, however, the same principles of operation can be used.

Muscle parameters were measured in vivo to characterize motor unitrecruitment. Motor unit recruitment is often characterized bystimulating individual motor axons from the peripheral nerve at theventral root. In small animals such as mice, however, this technique isimpractical.

FIG. 5A shows a stimulation cuff (e.g., synthesized optical lightsource) for placement around a peripheral nerve, consistent with anembodiment of the present invention. The stimulation cuff 502 isdepicted as having a curved portion designed to at least partiallysurround the peripheral nerve, however, other embodiments allow forvariations including, but not limited to, a cuff that predominantlysurrounds a peripheral nerve and point light sources. In the experiment,both electrical and optical stimuli were provided to an anesthetizedThy1-ChR2 mouse by way of such a cuff. The experiment was carried outusing an optical cuff (and compared to an electrical cuff) around thesciatic nerve of an adult Thy1-ChR2 or control (C57bl/6) mouse. Stimuliwere provided by the cuff to evoke an electrical and contractileresponse of the muscle.

FIG. 5B shows the muscles electrical response (M-wave) as measured byfine wire electrodes placed in the muscle belly and near the Achillestendon, consistent with an embodiment of the present invention. Thewaveform depicts an electromyography (EMG) plot of typical twitch fromoptical stimulation.

FIG. 5C shows the contractile force output as measured by a forcetransducer attached to the Achilles tendon, consistent with anembodiment of the present invention. In a mouse, the medialgastrocnemius (MG), the lateral gastrocnemius (LG) and the soleus (SOL)have free tendons that attach to the distal end of the Achilles tendon.To measure muscle forces of an individual muscle, the free tendons ofthe muscles not being measured are detached. The detached Achillestendon was fixed to a force transducer to measure muscle contractions.The force traces show typical titanic contractions at variousfrequencies using optical stimulation.

FIG. 5D depicts EMG and force traces from twitches elicited by opticaland electrical stimulations in both Thy1-ChR2 animals and controlC57bl/6 animals, consistent with an embodiment of the present invention.These traces show that typical twitch response generated by opticalstimulation from the MG does not have a significantly different shapethan twitches evoked by electrical stimulation in either Thy1-ChR2 orcontrol animals. The exception to this observation is the absence of astimulation artifact in the EMG response just prior to the initiation ofdepolarization under optical stimulation, but seen in all cases ofelectrical stimulation. There was no response to optical stimulation incontrol animals, which implies that optical stimulation occurs byphotostimulation of the ChR2 channels and not by heat or otherelectrical means.

To compare electrical and optical stimulation intensities the rectifiedintegrated EMG (iEMG) was used over the time of non-zero activity ineach trial. To verify that measurement of iEMG represents a commonresponse of the muscle under both electrical and optical stimulation andalso to verify that optical stimulation can elicit contractile forcescomparable to electrical stimulation, the average peak force during atwitch was compared to the iEMG response. FIG. 6A shows peak forceduring a single twitch vs. rectified integrated EMG for both electricaland optical stimulations, consistent with an embodiment of the presentinvention. For a given iEMG, both optical and electrical stimulationsproduce similar trends, but the peak twitch forces were on average 15.4%lower using optical stimulation. Average peak twitch forces usingelectrical stimulation (0.32±0.05 N) were significantly higher (p<0.01)than average twitch forces with optical stimulation (0.29±0.01 N),possibly indicating that most but not all motor neurons are stimulatedunder optical stimulation. Twitch forces produced by electrical andoptical stimulation are consistent with previous measurements.

Measurement of motor axon conduction latency is the most common methodused to estimate motor unit recruitment. Smaller axons have slowerconduction speeds, and therefore have longer latencies for a givendistance. FIG. 6B depicts average latency measured from initiation ofstimuli to detection of EMG, consistent with an embodiment of thepresent invention. Latency represents the time difference between theinitiation of the stimuli and the depolarization measured on EMG(M-wave). Latencies measured under optical stimulation for allintensities (2.18±0.02-1.72±0.13 ms) were significantly longer thanthose under electrical stimulation (1.15±0.05-0.99±0.01 ms, p<0.01 inall cases). This difference is possibly due to lower cation conductanceof ChR2 channels, which delays the formation of an action potential. Theconduction velocity was estimated (32.2−40.4 m s−1), due to significantuncertainty in the path length of the axon from the site of stimulationto site of measurement and found to be consistent with expected values.At the lowest levels of activity, the drop in latency from 1 mV ms to 2mV ms under optical stimulation was significant (p<0.01) while thedifference under electrical stimulation was not (p=0.11). This impliesthat smaller axons are recruited preferentially at the lowest levels ofoptical stimulation but not under electrical stimulation.

Other measures of motor unit recruitment, such as the contraction andrelaxation times, were found to suggest orderly recruitment with opticalstimulation. FIG. 6C shows the average contraction time measured from10% of peak force to peak force, consistent with an embodiment of thepresent invention. Under optical stimulation (11.1±0.08 ms), thecontraction time was significantly longer at the lowest levels of muscleactivity than electrical stimulation (8.79±1.01 ms, p<0.01). While atthe highest levels of muscle activity, contraction time under opticaland electrical stimulation was not found to be significantly different(8.34±0.07 ms, p=0.60).

FIG. 6D depicts average relaxation time measured from peak force to 10%of peak force, consistent with an embodiment of the present invention.This relaxation time was significantly longer at the lowest level ofmuscle activity with optical stimulation (21.73±0.39 ms) than electricalstimulation (17.46±0.68 ms, p<0.01), whereas relaxation time at thehighest levels of muscle activity were not significantly differentbetween the different types of stimulation (14.54±0.09 ms, p=0.10). Themeasurements of contraction and relaxation time, which are consistentwith other in vitro data, both imply that at the lowest levels of muscleactivity, optical stimulation preferentially recruits slower motor unitsthan electrical stimulation.

To further examine differential motor unit recruitment, the recruitmentof two different muscles, soleus (SOL) and lateral gastrocnemius (LG),were compared. FIG. 7A shows rectified-integrated EMG (iEMG) vs.estimated optical intensity at surface of the sciatic nerve for soleus(SOL) and lateral gastrocnemius (LG), consistent with an embodiment ofthe present invention. Whereas FIG. 7B shows rectified-integrated EMGvs. electrical stimulation voltage applied to the sciatic nerve,consistent with an embodiment of the present invention.

SOL contains 58±2% slow oxidative (SO) fibers and 0% fast glycolytic(FG) fibers, while LG has 69±13% FG fibers and 1±3% SO fibers. It hasbeen reported that smaller motor units tend to have higher compositionsof SO fibers, and therefore, it was expected that SOL motor units wouldbe recruited prior to the faster motor units of LG, an observation thathas been reported in physiological recruitment studies. FIG. 7C showsoptical intensity required to achieve maximum iEMG in SOL and LG,consistent with an embodiment of the present invention. Under opticalstimulation SOL (14.9±1.9 mW mm−2) reaches 95% peak activity at asignificantly lower optical intensity than LG (FIG. 7C, 24.4±1.9 mWmm−2, p<0.01). At the lower levels of optical stimulation, LG and SOLhave similar levels of activity. This observation can be attributed tothe possibility that LG contains small motor units composed of fastmuscle fibers.

FIG. 7D shows electrical stimulation required to achieve 95% of maximumiEMG in SOL and LG, consistent with an embodiment of the presentinvention. The electrical stimulation used to evoke 95% of peak activityin SOL (0.64±0.15 V) and LG (0.64±0.09V) was not significantly different(FIG. 7D, p<0.01). These findings suggest that slower muscle fibers arepreferentially recruited by optical stimulation before faster fibers;however, the order of motor unit recruitment would be more certain givenknowledge of the size distribution of the motor axons innervating eachmuscle.

To analyze axon size distribution, and to determine if there was bias inthe location of the axons innervating each muscle within thecross-section of the peripheral nerve, retrograde dye (Fast Blue) wasintramuscularly injected into the muscles of interest to backfill onlythe axons innervating the muscle in which it was injected. FIG. 7E showsan example cross-section of the sciatic nerve where retrograde dye wasinjected into the LG only, scale bar=100μ, consistent with an embodimentof the present invention.

FIG. 7F shows distribution of motor axon diameters for SOL and LG foundin cross-section of the sciatic nerve, consistent with an embodiment ofthe present invention. FIG. 7G shows depth of motor axons for SOL and LGfound in cross-section of the sciatic nerve, consistent with anembodiment of the present invention.

In cross-sections of the sciatic nerve (FIG. 7E) SOL and LG do notcontain significantly different numbers of motor axons (FIG. 7F,53.5±4.9, 55±3.7, p=0.71). However, the average motor axon innervatingLG had a significantly larger Feret's diameter than those innervatingSOL (6.7±0.16 μm, 4.5±0.17 μm, p<0.01). No bias was observed as to thelocation of either set of axons within the peripheral nerve so that oneset would be exposed to significantly higher light intensities thananother. These observations support the premise that small motor unitsare preferentially recruited under optical stimulation, and that theobserved difference in optical intensity required for peak muscleactivity in SOL and LG is not influenced by either number of axons orposition of those axons in the peripheral nerve.

To determine the location of the ChR2 channels within the motor axonsand whether there were any differences in expression levels in relationto the size of the motor axons, cross-sections of the sciatic nerve weremade both parallel and perpendicular to the long axis of the motoraxons. FIG. 8A depicts a confocal image of sciatic nerve incross-section, consistent with an embodiment of the present invention.The first channel is due to anti-laminin labeling basal lamina of theperipheral nerve. The second channel is due to YFP fluorescenceexpressed natively in the transgenic neurons, scale bar is 50 μm. FIG.8B depicts a confocal image of sciatic nerve in a longitudinal sectionwith the same staining as in FIG. 8A, illustrating several nodes ofRanvier, scale bar is 50 μm. The ChR2 channels are labeled with yellowfluorescent protein (YFP), so the average relative YFP fluorescenceintensity of axons was compared to the diameter of those axons usingconfocal microscopy.

FIG. 8C shows YFP fluorescence intensity versus motor axon size incross-section (n=4), consistent with an embodiment of the presentinvention. No correlation was found between axon size and fluorescentintensity in the transverse sections (FIG. 8C, R2=0.0021, p=0.88).Additionally it was possible to locate nodes of Ranvier within thecross-sections (FIG. 8B).

FIG. 8D shows the average fluorescence intensity parallel to the longaxis of sampled axons, where the origin indicates the center of the nodeof Ranvier (n=15, shaded region is s.d.), consistent with an embodimentof the present invention. The fluorescence, and presumably the ChR2channel density, varies along the axolemma. Fluorescence intensity atcenter of the nodal region is at a minimum, while fluorescence intensityin the peri-nodal region is at a maximum. It is known fromimmuno-localization studies that the center of the nodal region containshigh concentrations of Na+ channels, which is likely the cause of thelower fluorescent signal is this region. Additionally, the nodal andinternodal regional morphology appears normal, giving no indication forabnormal behavior of the transgenic motor neurons.

The ability to preferentially recruit slower motor units with opticalstimulation has potentially enormous functional significance. FunctionalElectrical Stimulation (FES) systems have been developed to serve asneuro-prosthetics for patients with paralysis, but have not been adoptedwidely because of early onset fatigue possibly due to reverserecruitment by electrical stimulation. To test whether opticalstimulation of muscle elicits less fatigue than electrical stimulation,measurements were taken of tetanic tension generated by the plantarflexor group of Thy1-ChR2 mice using both stimulation types. FIG. 9Ashows the average tetanic tension over two minutes in muscle beingstimulated with 250 ms trains at 1 Hz using electrical and opticalstimulation (n=7, shaded region is s.e.), consistent with an embodimentof the present invention. FIG. 9B shows the average fatigue index forelectrical and optical stimulation, measured as decline in tetanictension over two minutes (n=7, error bars are s.e., * indicates p<0.01),consistent with an embodiment of the present invention. Usingstimulation intensities in each modality that elicited 2× body weightfor each unfatigued mouse, 1 Hz stimulation trains were used for 2minutes, with each train lasting 250 ms. The average fatigue index,measured as the average tetanic tension of the last train divided by theaverage tetanic tension in the first train, declined significantly lowerin trials using electrical stimulation (0.11±0.09), than those usingoptical stimulation (0.56±0.09, p<0.01). Additionally, when this fatigueprotocol is extended to 20 minutes in an individual mouse usingcontralateral hindlimbs, electrical stimulation diminishes tetanictension to ˜0% after just 4 minutes, while optical stimulation continuesto elicit 31.6% of its initial tension after the entire 20 minute trial.FIG. 9C shows an example of tetanic tension taken from a single mouseusing both optical and electrical stimulation in contralateral hindlimbsover 20 minutes, consistent with an embodiment of the present invention.

Physiological measurements were taken according to the followingmethodology. Normal appearing, 9-12 week old Thy1-ChR2 or C57bl/6control mice were anesthetized and the hindlimb was shaved and fixed ina frame. The Achilles tendon was freed by cuffing the distal end of thecalcaneous to a force transducer (Aurora Scientific, 300CLR) by thinsteel wire. An optical cuff, made of 16 LEDs (Rohm, SMLP12BC7T, 465 nm)arranged in a concentric perimeter facing the peripheral nerve center,or a bipolar hook electrical cuff was inserted around the exposedsciatic nerve that is cut proximal to the site of stimulation. In mostcases optical and electrical stimulation were conducted in the same legat different times. Stainless steel hook electrodes were inserted fordifferential EMG recordings. EMG recordings were filtered in hardwareonly (BP 3-3000 Hz). All force, EMG, and stimuli data were sampled at100 kHz.

Imaging was implemented consistent with the following steps. Freshsciatic nerve was fixed in 4% PFA for 30 min and washed in PBS. Thesamples were then embedded in 5% low-melting point agarose and cut (50μm) with a vibratome. The sections were labeled with anti-tau andanti-lamin. The sections are imaged on a confocal microscope (Leica,DM6000). The number, size and fluorescence intensity of the motor axons(≧3 μm and G-ratio ≧0.5)33, 34 were determined by manual analysis inImageJ.

All other data analysis was conducted in Matlab. All data reported forthe MG was broken in arbitrarily defined bins based on iEMG value. Todetermine stimuli needed for 95% maximum iEMG in SOL and LG, a Weibullcumulative distribution function was fit to data points. The confidenceinterval (c.i.) generated by the curve fit was used to define the 99%c.i. of the required stimuli.

Samples tested for statistically significant differences were firsttested for normality using Lilliefors test (α=0.05), then tested usingunpaired two-tailed Student's t-test (α=0.05). All sample groups testedwere found to be of normal distribution, except for the axon size datawhich was tested using the Mann-Whitney U-test. All data points listedare mean±s.e.m. or data±99% confidence interval (c.i.) when referring toFIGS. 7C and 7D.

The specific implementations of the above-mentioned experiment, whileinstructive, are not meant to be limiting. The results, however, showthe versatility and broad-applicability of related methods, devices andtreatments, some of which are discussed hereafter.

In a specific implementation, the desired physiologic order isexaggerated by expressing inhibitory NpHR in the fast-twitch fiber motorneurons, providing a method to reduce or prevent fatigable muscle usagewhen not desired. This, however, might require long periods of yellowlight production, causing possible heating and reduction of batterylife. Mutant forms of channelrhodopsin that respond to different lightfrequencies can be used by expressing these different forms of ChR2 inslow and fast twitch fiber motor neurons, thereby creating a definitivesystem where each could be controlled separately using the differentlight frequencies. Variations and combinations are contemplatedincluding, but not limited to, multiple forms of ChR2 used incombination with NpHR.

Targeted expression can be accomplished using a cell specific promoter.Examples of cell specific promoters are promoters for somatostatin,parvalbumin, GABAα6, L7, and calbindin. Other cell specific promotersare promoters for kinases such as PKC, PKA, and CaMKII; promoters forother ligand receptors such as NMDAR1, NMDAR2B, GluR2; promoters for ionchannels including calcium channels, potassium channels, chloridechannels, and sodium channels; and promoters for other markers thatlabel classical mature and dividing cell types, such as calretinin,nestin, and beta3-tubulin.

Other aspects of the present invention use spatial properties of thelight stimulus to control the activation of the desired motor neurons.For instance, the use of a LED-based nerve cuff, e.g., a stimulationdevice 202, includes controllable light sources that provideillumination from respective portions of the cuff. The light sources inthe different portions of the illumination device are designed to beseparately addressable. Calibration techniques can be used to determinethe optimal stimulus profile. For example, it may be determined thatoptical stimulation from a first portion of the illumination deviceactivates higher percentage of fast twitch fiber motor neurons withrespect to optical stimulation from another portion of the illuminationdevice. Optical stimulus from this portion can be reduced or avoidedaltogether when fine motor control is desired. Similarly, when NpHR isused, yellow light can be used from such a portion to reduce activationof fast twitch motor neurons.

According to embodiments of the present invention, an opticalstimulation system is configured to provide graduated levels of opticalstimulation according to the desired muscle contraction strength. Forfine motor control, the optical stimulation is relatively low and/ortargeted at the slow twitch motor neurons. For increasingly strongand/or rapid contractions, additional motor neurons are recruitedincluding the fast twitch motor neurons. The graduated levels can beimplemented as a function of the respective ratio of fast to slow twitchmotor neurons that are responsive to a particular aspect of the opticalstimulation. Example aspects include the optical wavelength, opticalintensity, duration of optical stimulus and/or the location of theoptical stimulus. A stimulation profile can then be determined toprovide the desired responsiveness ranging from slow/fine control tofast/coarse control of the particular muscle group. This can beimplemented using an algorithm that takes a desired response anddetermines the optical parameters corresponding to the response.Alternatively, a look-up table, having stored optical parameters thatare indexed according to the desired motor response, can be used.

Optogenetic techniques offer novel therapies in several areas. Exampleapplications include, but are not limited to, muscle stimulation,spasticity, tremor, chorea suppression, pain management, vagus, phrenic,and sacral nerve stimulation, cardiac arrhythmia management, and stemcell therapies.

Embodiments of the present invention relate to treatment orcharacterization of a patient suffering from spasticity. Spasticity is adevastating and common human clinical condition that arises as a resultof neonatal injury (e.g., cerebral palsy), genetic disease (e.g.,Niemann-Pick disease) and postnatal injury (e.g., spinal cord injury andstroke), and is characterized by hyperreflexia which leads toinvoluntary muscle contraction in response to movement. Spasticitylimits the daily activities of more than millions worldwide, and isestimated to cost billions of dollars in the United States alone. Thereare a number of medical and surgical treatments for spasticity,including botulinum toxin, intrathecal baclofen, selective dorsalrhizotomy, and gene therapy; however most, if not all, can causesignificant side-effects, have limited efficacy, and can beprohibitively expensive. It is extremely difficult to “turn down” theoveractive nerves that cause severe muscle contraction, abnormalposture, and pain, since drug approaches are slow and nonspecific withregard to cell type, and electrodes cannot effectively or precisely turndown neural activity, or attain cell type specificity. In many casesphysicians will resort to risky surgeries like dorsal rhizotomy, butthis can only be done in a minority of spastic patients and hasinconsistent efficacy with the potential for serious adverse events.

Consistent with an embodiment of the present invention, both ChR2 andNpHR channels/pumps are expressed in the affected motor neurons, and anerve cuff, or other light source capable of producing both yellow andblue light, is placed around the nerve. The combination of both ChR2 andNpHR allows for spasticity to be reduced while maintaining musclefunction and strength. The stimulation pattern could either be based ona learned feedback pattern (such as those used to control prostheticlimbs) or could be controlled more explicitly by the user (deciding, forexample, to leave the muscle limp for a period of time in order torest).

For instance, the spastic motor control can be effectively overriddenusing a combination of ChR2 and NpHR stimulation. Electromyographydevices can be used to detect the activation signal of muscles, e.g., asensor/microchip can be implanted in muscles to detect electricalsignals from the brain. These signals are transformed into correspondingoptical stimulus. A trained technician or biomedical engineer canconfigure an initial (coarse) response relative to the optical stimulusdevice. Over time the patient can learn to finely control the opticalstimulus device so as to perform the desired movements.

In a similar manner, optogenetic therapy is used to control tremors orvarious forms of chorea. Motion detection coupled in a feedback mannerto ChR2 and NpHR stimulation could effectively provide a low-pass filterfor muscle activation, or one in which certain patterns of activation(the specific tremor or choreic motions) were dampened. For example,accelerometers or gyros can be used to provide motion-detectionassociated with the muscle responsive to the stimulation. In response tomotion exceeding a threshold level of forcefulness, speed and/orrepeated motions, dampening stimulation can be provided. The thresholdlevel can be adjusted to allow for suitable movement by the patientwhile also providing sufficient dampening functionality. The opticalstimulation device can have an adjustable setting for this dampeningfunctionality.

In one implementation, one or more additional accelerometers or gyroscan be placed at the core of the patient. These accelerometers or gyrosdetect motions associated with the entire individual rather than aspecific limb or other body part. When such motion is detected, it canbe used to distinguish between motions caused by external forces (e.g.,riding in a vehicle) from unwanted spastic motions.

Other embodiments of the present invention relate to treatment orcharacterization of chronic pain. Millions of people are adverselyaffected by chronic pain. Chronic pain causes billions of dollars a yearin medical costs, lost working days, and workers compensation, and is amajor risk factor for depression and suicide.

Pain can be divided into two general categories: nociceptive andneuropathic. In the former, mechanical, thermal, or chemical damage totissue causes nociceptor response and initiates action potentials innerve fibers. Afferent fibers terminate directly or indirectly ontransmission cells in the spinal cord that convey information to thebrainstem and midbrain. Neuropathic pain, in contrast, involves amiscoding of afferent input; mild inputs yield dramatic pain responses,through mechanisms that are not well understood. Often this is theresult of an initial nociceptive pain that, instead of resolving withhealing of the initial stimulus, proceeds to spontaneous pain andlow-threshold for light touch to evoke pain. It is believed thatincreased sodium channel and decreased potassium channel expression indorsal root ganglia, the development of “cross-talk” between adjacentafferents, or an increase of glutamate release in spinal cord neuronsare among the possible mechanisms for this increased pain sensitivity.

Treatment of pain depends on many factors, including type, cause, andlocation. There are myriad options, most notably topical agents,acetaminophen and NSAIDs, antidepressants, anticonvulsant drugs, sodiumand calcium channel antagonists, opioids, epidural and intrathecalanalgesia, acupuncture and other alternative techniques, botulinum toxininjections, neurolysis, cryoneurolysis, spinal cord stimulation,neurosurgical techniques, radiofrequency ablation, peripheral nervestimulation, transcutaneous electrical nerve stimulation, andrehabilitation therapy.

So many treatments exist, however, because each has limitations. Forexample, local anesthetic drugs block sodium channels, preventingneurons from achieving action potentials. However, effectiveness of thistreatment is limited by the degree to which specificity for pain neuronscan be maintained, avoiding the side effects of numbness or paralysisfrom blocking other sensory or motor fibers (as well as potentialcardiac effects should the drug travel further through the circulatorysystem). In order to achieve this, low dosages are needed, requiringfrequent administration of the drug. Additionally, not all kinds of painreact to local anesthetic treatment, and some cases become refractoryover time, or require ever increasing doses.

Surgical treatments, including dorsal or cranial nerve rhizotomy,ganglionectomy, sympathectomy, or thalomatomy, are more drastic options,appropriate in certain severe cases. However, relief from these isunpredictable; notably, it is sometimes only temporary, and may involvecomplications. Spinal cord stimulation (SCS) is also used in some cases,attempting to limit chronic pain through placement of electrodes in theepidural space adjacent to a targeted spinal cord area thought to becausing pain; however, a recent review found limited evidence of theeffectiveness of this technique.

Alternately, pain can be addressed in the brain. As it is correlatedwith depression and anxiety, pain is sometimes responsive toantidepressant and anti-anxiety medications such as the tricyclics.Recent promising research suggests the effect of real-time fMRIbiofeedback, where patients learn to decrease activation of the rostralanterior cingulate cortex, with resultant reduction in perceived pain.While each of these methods is effective in some cases, chronic painremains a largely intractable problem. NpHR and ChR2 expression inperipheral afferent nerves is therefore used to influence pain signals.

Control of the peripheral afferent fibers with the high temporalprecision of optogenetic techniques offers the ability to inhibit painsignals at a given moment, as with local anesthetic treatment. Forinstance, NpHR can be engineered in afferent nerves and optical stimuluscan be provided to the NpHR to provide anesthetic treatment. The opticalstimulus can be relatively constant or responsive to an externalcontrol. For instance, a doctor or patient can control the delivery ofthe optical stimulus in terms of frequency of stimulus, intensity ofstimulus or simply turn the stimulus on or off. The temporal propertiesof ChR2 and NpHR can also be used to interface with and reprogram painrecognition in the CNS. Reprogramming can be implemented as suggested byelectrical stimulation, antidepressant medication and biofeedbackmechanisms.

The temporal precision and nerve specificity of optogenetic stimulationis particularly useful for reprogramming pain recognition circuits.Response to pain can be “turned up” in neuropathic conditions, creatinghypersensitivity to afferent stimulation, suggesting that it is possibleto reverse this through other patterns of stimulation. Particularembodiments relate to stimulating pain fibers and larger sensory fibersseparately, as larger sensory fiber messages tend to overwhelm and turndown pain fiber recognition.

Embodiments of the present invention also relate to vagus nervestimulation. The vagus nerve is composed of both afferent and efferentpathways. In the peripheral nervous system, vagal afferent fibersinnervate the heart, vocal cords, and other laryngeal and pharyngealmuscles, and also provide parasympathetic input to the gastrointestinalviscera. Afferent fibers project mainly to the brain, in such regions asthe pontine and midbrain nuclei, the cerebellum, thalamus, and cortex.

Given this variety of nerve function, vagus nerve stimulation is usedfor a wide range of treatments, including appetite management, cardiacrate suppression, depression, and epilepsy. In the latter two,effectiveness of the treatment is not well understood. The right vagusnerve provides more innervation to the cardiac atria than the left vagusnerve does, so in situations where cardiac effects are not desirable,electrical stimulation is generally performed on the left side. However,even with these precautions, side effects such as hoarseness, throatpain, coughing, shortness of breath, tingling, and muscle pain arerelatively common in patients receiving vagus nerve stimulation. Evenmore dangerous, bradycardia followed by transient asystole is reportedin association with tests during stimulator implantation and there isone case report of bradycardia and asystole with syncope in a patientafter two years of wearing the device.

Optogenetic techniques are particularly useful for parsing through thevarious functions of the vagus nerve and to stimulating only theparticular neurons that are of interest. Selective stimulation mitigatesthe unwanted side effects, particularly the potentially life-threateningcardiac events.

Aspects of the present invention are also particularly useful forstudying the effects of vagus nerve stimulation. Little is known aboutwhy vagus nerve stimulation is effective in treating epilepsy anddepression. Optogenetic techniques provide a means of studying andimproving these treatments. In animal models, ChR2 expression in varioustypes of vagal fibers allows for the identification of the specificfibers best suited for stimulation. Once these fibers of interest areidentified, therapies could be modulated so that only these fibers arestimulated, thus avoiding unwanted side effects.

In certain embodiments, inhibition is desired, rather than stimulation.Vagus nerve techniques for appetite suppression involve either severingthe nerve or over-stimulating it so that it no longer has meaningfuleffect on the gastrointestinal system. However, damage to the vagusnerve can cause gastroparesis, where the stomach no longer propels foodforward through the digestive system, causing nausea, vomiting, anddangerous fluctuations in blood sugar levels.

In one such embodiment, NpHR is used to provide a more targetedtechnique to depress vagus nerve firing. The optical stimulation of theNpHR can be provided to specific times, such as during meals, to moreclosely mimic natural physiology. For example, optical stimulation couldbe responsive to patient input indicating consumption of food.Alternately, one could bypass the vagus nerve and instead express ChR2in the muscles of the proximal stomach. These muscles relax to allow thestomach to expand while eating; blocking or mitigating this expansionthrough ChR2 stimulation would create a premature sense of satiety,similar to the effects of gastric bypass surgery. Selection of onetreatment method over the other can be determined as a function of theability to directly control stomach muscle movement against thecomplexity of needing a light source for the entire stomach muscleregion rather than a small cuff for the vagus nerve.

Other aspects of the present invention relate to cardiac applications.Abnormal heart rhythms, such as atrial fibrillation or atrial flutter,are often treated using defibrillation and cardioversion. Thesetreatments are based on the concept of creating a large electrical fieldto interrupt the abnormal heart rhythms, thereby allowing the heart toreturn to normal rhythm. This is also the basis for externaldefibrillation, used to resuscitate patients that otherwise would dieusing an external shock system. Implantable defibrillators have becomethe standard of care in patients felt to be at high risk forlife-threatening rhythm abnormalities called ventricular tachycardia orventricular fibrillation. These devices have several majorlimitations—one of the greatest limitations is the need for a painfulshock and potential for symptoms prior to conversion due to theinability of the device to prevent the rhythm from occurring orprogressing prior to the shock. The shock is not desirable since it ispainful and creates patient anxiety, resulting in an impairment ofquality of life.

For atrial arrhythmias such as atrial fibrillation, techniques such ascatheter ablation often do not completely eliminate atrial fibrillation.Since there are estimates of millions of patients currently with atrialfibrillation, a substantial numbers of patients may remain in atrialfibrillation. Atrial fibrillation results in an increased risk of strokein most patients and may be highly symptomatic. For many of thesepatients, electrical cardioversion is possible but requires anesthesiato be administered with its resulting inconvenience and cost.Implantable defibrillators, although approved for this indication, havenot been utilized for atrial fibrillation: the discomfort of the shockis not well tolerated, and only about 50% of atrial fibrillationepisodes are converted by maximum energies in current implantabledefibrillators.

Consistent with a specific implementation, local activation of cells inspecific regions or with specific cell types is used to assess the roleof the cells in the genesis of arrhythmias. There are two fundamentalmechanisms that might be employed to convert atrial or ventriculararrhythmias. The first mechanism brings localized regions of hearttissue in specific geometric relationships to reach subthresholdpotential so that the abnormal rhythm stops. The second mechanismcontrols afferent sympathetic and parasympathetic nerves with opticalstimulation. In the first mechanism, the subthreshold regions createfirewalls around the regions of initiation of the ventriculartachycardia or ventricular fibrillation so that the rhythm would notactually start, while in the second mechanism the vagus nerve itself(for example) can be accessed at a position where the cardiac fibers arestill embedded.

Embodiments of the present invention are particularly useful forreplacement of supplementation of electrical stimulation therapies thattarget phrenic and sacral nerves. The phrenic nerve controls thediaphragm, and implantable electrodes can be used as an alternative tomechanical ventilators for long term ventilation-support needs. Becausethe phrenic nerve is relatively isolated and has few functions beyonddiaphragm control, electrical stimulation is generally an effectivetechnique. Side effects, however, come from the initial surgery toimplant the electrodes, which may include thoracotomy. There is alsoreport of chest pain with stimulation at high intensity, due tosimultaneous stimulation of phrenic nerve afferent fibers, though thisis generally fixed by lowering the stimulation levels.

Optogenetic techniques can be useful for avoiding the need forthoracotomy to implant the electrodes. With the specificity provided bygenetic targeting, accidental stimulation of unwanted nerves can bemitigated or completely prevented. Therefore an LED cuff (or alternatelight source) could be installed above the rib cage, where the nervefirst leaves the spinal cord. This would avoid the need for apotentially dangerous thoracotomy, and would hasten post-operativerecovery time.

The sacral nerve influences bladder and bowel control, and may bedamaged either in paraplegia, or as a side effect of radicalprostatectomy. Correct bladder control is the product of carefulcoordination of the detrusor and sphincter muscles, as controlled bysacral nerve parasympathetics and thoracic nerve sympathetics. Whilefilling, the sphincter muscles must remain strongly activated, while thedetrusor muscles relax to allow the bladder to stretch, as monitored bystretch receptors. Bladder release requires coordination of these samemuscles in the opposite fashion: sphincter muscles release followed bydetrusor muscle contraction. Failure to synchronize these events isknown as detrusor-sphincter dysenergia (DSD).

Electrical stimulation suppresses hyperreflexia of the detrusor muscle,allowing for increased bladder filling and increased time betweenvoiding, however DSD is sometimes a side effect of stimulation.Alternately, dorsal rhizotomy is sometimes performed to increase bladdercapacity and provide urinary continence. However, both of thesetechniques are clearly limited; one can either stimulate or cutinnervation, but not do both in carefully timed succession as would beneeded for true restoration of function. With the genetic targetingtechniques, and light cuffs implanted around the sacral and thoracicnerves, optogenetic techniques allow control of the sphincter anddetrusor muscles, so that stimulation and inhibition of each could beachieved with high synchrony, effectively recreating normal bladderphysiology.

Other embodiments of the present invention relate to uses of stem cells.The success of bone marrow transplantation demonstrates the greatpromise of stem cell research. However, in many areas of stem cellresearch, potential therapies still face major technical hurdles. Whileinjected stem cells will often successfully repopulate cells in theneeded area, it is difficult to guarantee that these new cells willperform the needed function.

One promising field of research is the use of skeletal myoblasts andstem cells to treat myocardial infarctions and heart failure.Intravenous injection of these cells does improve cardiac function, butthere is significant concern that the treatment may be arrythmogenic,either because of the electrical properties of the injected cells, orbecause of damage or increased nerve sprouting from the injection.

A second major research area is the use of stem cell injections to treatspinal cord injury. Here it is difficult to establish what types ofcells are most appropriate in order to bridge the injured area and torestore function. A cell that is less differentiated has more potentialto react to the environmental cues to produce the needed variety ofcells; however, it also has more potential to differentiate to produceunwanted cell types, creating the danger of teratomas and othercancerous growths. Also, even once the cells are in place, they may ormay not integrate into the neural circuit and become functional.

Optogenetic techniques can be used to solve some of the problems facedby stem cell therapies, particularly in cases such as the cardiac,muscular, and nervous systems, where the cells need to perform specificelectrical tasks. Stem cells are often genetically modified prior toinjection; the inclusion of ChR2 and NpHR would allow direct control ofthe electrical properties of the transplanted cells, insuring that cellswill be functional.

In the case of myocardial repair, tonic NpHR inhibition could be used toprevent arrhythmia, as discussed previously. A detector noting changesin the potential fields around cardiac pacemaker cells could triggerstimulating light pulses, so that the new cells would fire in synchronywith the native myocardial cells.

With spinal cord injury, it may be possible to use optogeneticallymodified stem cells directly at the site of injury. Knowledge of thecomplex circuitry can be used to determine and provide the needed lightstimulation patterns. An alternative implementation uses modifiedskeletal muscle stem cells (“satellite cells”) to repopulate muscleswith cells that are responsive to optical control. For example, afterspinal cord or nerve injury, denervated muscle begins to atrophy fromlack of use. Rather than attempt to reinstitute peripheral nerve supply,one could use optical stimulation to control a newly grown population ofskeletal muscle cells.

Muscle fibers evolve and change type from slow to fast twitch and thereverse, according to patterns of stimulation. Accordingly coordinationof stimulation patterns to specific muscle types is implemented.Establishment of different populations of satellite cells that respondto different frequencies of light allows for independent control of slowand fast twitch muscle fibers.

For the various embodiments of the present invention discussed herein,one concern is the ability to effectively use gene therapy withoutsignificant side-effects. Animal studies have thus far shown that theexpression of these types of foreign proteins in neuron cell membranesdoes cause an immune response. Notwithstanding, inflammatory effects canbe countered using oral peptide-tolerization strategies or mild oralimmunosuppression strategies, which can specifically reduce inflammatoryresponses. Further advances in gene therapy and immune suppressiontechniques will help to minimize these risks.

Moreover, these types of side-effects are relatively minor when comparedto many of the severe ailments that can be treated, such as for intensechronic pain and severe cardiac arrhythmias. With progressively safergenetic techniques, the therapies proposed herein become increasinglyviable, and optogenetic therapies may be the preferred approach evenwhen they offer only slight benefits over traditional techniques.

The invasiveness of implantation surgery, scarring around electrodes orlight sources, longevity of electronics and power supplies, and batteryrequirements in the case of power supply implantation, or possibleinfection risks if wire leads are needed to connect to a power supplyoutside the body can be mitigated using biocompatible materials and/orpower supplies.

While the present invention has been described above, the skilled in theartisan will recognize that many changes may be made thereto withoutdeparting from the spirit and scope of the present invention. Suchchanges may include, for example, the implementation of one or moreapproaches involving variations of optically responsive ion channels.These and other approaches as described in the contemplated claims belowcharacterize aspects of the present invention.

What is claimed is:
 1. A method comprising: engineering light-responsivechannels or pumps in a set of motor units that includes motor unitshaving respective motor neurons of different physical sizes; determiningan optical stimulus profile as a function of a recruitment order of theset of motor units that corresponds to the different physical sizes ofthe motor neurons; and providing the optical stimulus profile to thelight-responsive channels or pumps.
 2. The method of claim 1, whereinthe step of determining an optical stimulus profile includes correlatingan activation of increasingly larger physical sizes of the motor neuronsto the optical stimulus profile.
 3. The method of claim 1, wherein thestep of determining an optical stimulus profile includes correlating amuscle fatigue factor to the optical stimulus profile.
 4. The method ofclaim 1, wherein the step of providing optical stimulus profile includesincreasing an intensity of providing optical stimulus profile to recruitmotor units having increasingly larger motor neurons.
 5. The method ofclaim 1, wherein the step of providing the optical stimulus profile isimplemented using a curved optical delivery device that at leastpartially surrounds the motor neurons of the set of motor units.
 6. Themethod of claim 1, wherein the step of engineering includes engineering,in fast twitch motor units, first light-responsive channels having afirst optical response profile; and engineering, in slow twitch motorunits, second light-responsive channels having a first optical responseprofile, wherein the first optical response profile and the secondoptical profile have respective peak sensitivities to differentwavelengths of light.
 7. The method of claim 6, wherein the step ofproviding the optical stimulus profile includes providing an opticalstimulus at a wavelength sufficient to activate the slow twitch motorunits without activating the fast twitch motor units.
 8. The method ofclaim 1, further including the step of sensing a neural activationsignal and wherein the step of providing optical stimuli is responsiveto the sensed neural activation signal.
 9. The method of claim 1,further including the step of calibrating the optical stimulus profileas a function of contractile strength of the motor units in response tothe optical stimulus profile.
 10. The method of claim 1, furtherincluding the step of sensing spastic motion of a portion of the bodyand wherein the step of providing the optical stimulus profile isresponsive to the sensed spastic motion and mitigates the spasticmotion.
 11. The method of claim 1, wherein the light-responsive channelsor pumps are one of ChR2, NpHR and variants thereof.
 12. A methodcomprising: engineering light-responsive channels or pumps in a set ofmotor units that includes motor units having respective motor neurons ofdifferent physical sizes; and providing optical stimuli to thelight-responsive channels or pumps at an optical intensity that is afunction of the different physical sizes of the motor neurons to berecruited.
 13. A method comprising: engineering light-responsivechannels or pumps in a set of peripheral afferent nerves; and providingoptical stimuli to the light-responsive channels or pumps to mitigatepain.
 14. The method of claim 13, wherein the step of engineeringincludes engineering NpHR in the peripheral afferent nerves and the stepof providing optical stimuli is responsive to an external control signalindicating a desired stimulus profile.
 15. The method of claim 13,wherein the step of providing optical stimuli includes providing anoptical stimulus pattern to modify pain recognition in the centralnervous system.
 16. A method comprising: engineering light-responsivechannels or pumps in a set of vagal fibers associated with thegastrointestinal system; and providing optical stimuli to thelight-responsive channels or pumps to mitigate appetite.
 17. The methodof claim 16, wherein the step of engineering includes engineering NpHRin the set of vagal fibers and wherein the step of providing opticalstimuli is responsive to an indication of meal time.
 18. A methodcomprising: engineering light-responsive channels or pumps in a set ofskeletal muscle stem cells; implanting the set of skeletal muscle stemcells at a target location within a muscle to repopulate the muscle; andproviding optical stimuli to the light-responsive channels or pumps tocause activation of the muscle at the target location.
 19. The method ofclaim 18, wherein the step of implanting includes implanting the set ofskeletal muscle stem cells for myocardial repair.